Florida Municipal Pension Trust Fund 457(B) Deferred Compensation Plan Participation Agreement
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2Florida Municipal Pension Trust Fund
457(b) Deferred Compensation Plan
Participation Agreement
IDENTIFYING INFORMATION
SSN ____________________________________________ Employer Name
Mr/Mrs/Ms First Name ___________________________ Middle Initial________ Last Name
Home Address _________________________________
City __________________________
State_________ Zip ______________ Home Phone _______________________________ Date of Birth
Email ___________________________________ Work Phone ____________________________ Date of Hire _______________
PAYROLL INFORMATION
Effective Date: ________________
Salary Reduction per pay:
________% or $ ________x______ Number of Pays = EE Annual Contributions $ _________________*
Age 50 catch‐up contribution:
$ ________x______ Number of Pays = EE Annual Contributions $ _________________*
Pre‐retirement catch‐up contribution:
$ ________
**
*Cannot exceed IRC Limits
** Cannot exceed IRC Limits. You must also complete the 457 catch‐up form
BENEFICIARY DESIGNATION
This designation revokes any previous beneficiary designation for this Plan. Unless you specify otherwise, if you designate
more than one beneficiary in any one class, the beneficiaries in the class will share equally.
□
Primary Beneficiary(ies): If more than two (2), attach additional sheets and check here
(1) Name
Relationship:
Social Security Number
Percentage:
(2) Name
Relationship:
Social Security Number
Percentage:
Contingent Beneficiary(ies):
(1) Name
Relationship:
Social Security Number
Percentage:
(2) Name
Relationship:
Social Security Number
Percentage:
(3) Name
Relationship:
Social Security Number
Percentage:
(4) Name
Relationship:
Social Security Number
Percentage:
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